Systemic and splanchnic hemodynamic changes after liver transplantation for cirrhosis: A long-term prospective study

Abstract

The effect of orthotopic liver transplantation (OLT) on the systemic and splanchnic hemodynamic alterations of cirrhosis is still largely unknown. The aim of this study was to prospectively investigate the long-term changes induced by OLT on several hemodynamic parameters. In 28 patients undergoing OLT for cirrhosis, the following parameters were measured before surgery and subsequently at 6-month intervals (mean follow-up period, 17 months): cardiac index, mean arterial pressure (MAP), heart rate, total peripheral resistance (TPR), portal vein flow velocity and flow volume, spleen size, and Doppler ultrasound resistance or pulsatility indexes (RI or PI) in the: 1) interlobular renal, 2) superior mesenteric, 3) splenic, and 4) hepatic arteries. The same parameters were measured in 10 healthy controls. After OLT, cardiac index and heart rate significantly decreased (P F .01), while MAP and TPR increased (P F .001), so that any significant difference from controls disappeared. Renal RI progressively decreased, achieving a significant reduction (P F .05) to normal values at the 12th month of follow-up. Portal flow velocity and hepatic and splenic RI returned to values not significantly different from controls. Portal flow volume increased over normal values after OLT (P F .001), and SMA PI, lower than normal before OLT, did not show any statistically significant increase thereafter. Spleen size decreased significantly, but persisted to be larger than in controls. In conclusion, systemic, renal, and most, but interestingly not all, splanchnic circulatory alterations of cirrhosis are restored to normal after OLT. (HEPATOLOGY 1999;30:58-64.)Advanced cirrhosis is accompanied by a peculiar hemodynamic derangement, which has been traditionally included in the hyperkinetic circulatory syndromes. 1,2 This derangement is characterized by high cardiac output, low total peripheral resistance (TPR), mild tachycardia, and low/normal blood pressure, and by various alterations in the peripheral circulation. 2 Among the latter, the most important are those occurring in the renal and splanchnic vascular beds.There is evidence that elevated portal resistance and liver failure are responsible for triggering the circulatory alterations of cirrhosis. 2,3 However, while it is accepted that orthotopic liver transplantation (OLT) restores normal portal resistance and pressure and liver function, 4 conflicting data have been reported about the corresponding modification of the hyperkinetic circulation 5 : some authors found a persistence of elevated cardiac output, 6,7 whereas others found a decrease to normal values. 4,8 No definite explanation accounting for such discrepancy has been proposed until now. Thus, it is still unclear whether or not the cardiac hyperkinetic circulation persists after OLT.The renal circulation of cirrhotic patients is characterized by an arteriolar vasoconstriction, which is especially intense in ascitic patients. 9,10 The two most likely mechanisms inducing renal vasoconstriction in cirrhosis are hypothesized ...

Change in platelet count in patients with hypersplenism subjected to liver transplantation

“…It has been suggested that in cases of splenomegaly, the structural changes in the spleen, including fibrosis and hyperplasia, do not allow the complete return to normal size following normalization of portal hypertension after LT (2,4) . Thus, some degree of splenomegaly and thrombocytopenia persists in a significant number of patients who have been subjected to LT (12) . The findings of this and other studies have clinical importance.…”

Changes in portal vein flow after adult living-donor liver transplantation: Does it influence postoperative liver function?

“…16 During liver transplantation, these alterations are maintained, but they tend to disappear during the following months. [17][18][19] This hyperdynamic state has not been a serious problem in cadaveric liver transplantation, in which a whole organ is placed orthotopically.…”

Hepatorenal Syndrome

“…Indeed, subsequent to liver transplantation, renal sodium excretion and hemodynamic abnormalities normalize within 1 mo, and renal resistive indices decrease to normal values during the first posttransplantation year (131,132). Survival of patients with type 2 HRS is sufficiently prolonged to enable them to receive a liver transplant; however, the clinical applicability of transplantation in patients with type 1 HRS is limited by their shortened survival expectancy and long waiting times.…”